Full dose of Hepatitis B vaccination and its associated factors among Healthcare workers in Sub-Saharan African countries: A Systematic review and Meta-analysis

Full dose of Hepatitis B vaccination and its associated factors among Healthcare workers in Sub-Saharan African countries: A Systematic review and Meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Full dose of Hepatitis B vaccination and its associated factors among Healthcare workers in Sub-Saharan African countries: A Systematic review and Meta-analysis Tsegasilassie Gebremariam Abate, Eyob Akalewold Alemu, Fetlework Gubena Arage, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7667813/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In low-income countries, especially in Sub-Saharan Africa, the low uptake of hepatitis B vaccine, coupled with high infection burden for hepatitis B, makes health-care workers vulnerable for acquiring the infection. The objective of this study was to determine the pooled prevalence of full dose of hepatitis B vaccine and identify associated factors among health care workers in Sub-Saharan Africa. Method PubMed, Scopus, Embase, and Google Scholar were systematically searched using Boolean operators. Eligible cross-sectional studies published from January 2017 to December 2024 in English with a quality score of 75% and above using Joanna Briggs Institute’s checklist were included for further review and analysis. Studies were screened for their consistency with the title, abstract and research question. The pooled prevalence of full dose hepatitis B vaccination and the effect size of associated factors were estimated using DerSimonian and Laird’s random-effect model. Heterogeneity among studies was assessed using I² statistic and Cochran’s Q test. Subgroup analysis and sensitivity analysis were conducted to identify the source of heterogeneity and the effect of single study effect on the pooled estimates. Egger’s test, funnel plot and trim and fill was also performed to assess publication bias. Result 19 studies out of 1377 articles assessed met the inclusion criteria and were included for further analysis. The estimated pooled full dose of HBV vaccine among health care workers was 38% (95% CI: 24%–51%). Male gender, training on infection prevention and screened for hepatitis b virus before were found to be significant factors associated with full dose vaccination. Conclusion The level of full dose vaccination for Hepatitis B vaccination among health care workers was low and needs more attention. Routine hepatitis screening and infection prevention training contributes for the full coverage of hepatitis B vaccination among health care workers. Hospitals and health facilities should prepare and deliver health education tailored for health care providers working at clinical settings and at risk of hepatitis B infection to achieve full dose vaccination coverage. Policies, strategies, campaigns and educations have to implemented to improve HBV vaccination for health care workers in Sub-Saharan Africa with a particular attention for female providers . Registration: This systematic review protocol was registered on PROSPERO with ID CRD42025635990 Hepatitis B virus Immunization Developing countries Health personnel Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Introduction Hepatitis B virus (HBV) infection can lead to a multiple liver diseases and complication including acute and chronic hepatitis, cirrhosis, and also hepatocellular carcinoma ( 1 ). The virus is transmitted primarily through vertical transmission, sexual contact, and parenteral exposure with blood, blood products and body fluids ( 2 ). It is one of the major global public health problem, with nearly 1 million deaths annually, and an estimated 316 million people with chronic infection in 2019 ( 3 , 4 ). The World Health Organization (WHO) western pacific and African region contributes the highest endemicity with 97 million and 65 million cases, respectively ( 5 ). Healthcare workers (HCWs) are at high risk of acquiring HBV infection due to their occupational exposure to blood, body fluid and needle-stick injuries ( 6 ). Among HCWs working globally, approximately 3 million each year have exposure to HBV, leading to up to 66 thousand infections and 61 deaths ( 7 ). In response, WHO recommend HBV vaccination for adults who are at risk of acquiring infection such as persons with current or recent injection drug use and HCWs, as part of its strategy to eliminate hepatitis by 2030 ( 8 ). According to the Centers for Disease Control and Prevention (CDC), three dose of HBV vaccination provides an approximate protection rate of greater than 90% in individuals aged less than 40 years ( 9 ). Despite this recommendation, full-dose HBV vaccination among HCWs remains suboptimal, particularly in low- and middle-income countries (LMICs) due to multiple reasons such as vaccine unavailability, higher costs and busy work schedules ( 10 ). A multi-country study in Afghanistan, Haiti, Malawi, Nepal, and Senegal revealed a significant disparities, with coverage ranging from 11.3% in Haiti to 69.1% in Afghanistan which was influenced by professional qualifications, education years and also gender ( 11 ). In Sub-Saharan Africa (SSA), the full-dose HBV vaccination coverage among HCWs ranges widely from 13.4% in central Africa to 42% in Nigeria ( 12 ). A meta-analysis reported in 2018 showed the pooled estimated level in the region was 24.7% with the different coverage ranging from 13.4% in central Africa to 62.1% in Northen Africa ( 10 ). After 2018, multiple primary studies assessed vaccination status among HCWs in SSA. In Mozambique, 13.3% of HCWs reported receiving full dose of vaccination ( 13 ). Another study in Uganda, a cross-sectional study reported 81.3% of HCWs completed three doses series ( 14 ). Studies in Kenya and Rwanda showed 53.1% and 96% completion rate of the three-dose schedule among HCWs, respectively ( 15 , 16 ). These Current reports indicate there is continuing suboptimal and varied rates across the regions. There remains a critical need to update the pooled estimate of full-dose HBV vaccination coverage among HCW in SSA since 2017 and determine whether the coverage has improved, stayed the same or declined, and analyze regional disparities and determine factors associated with it. This study addresses these gaps by synthesizing data from studies published since 2017 to provide a current estimate of HBV vaccination coverage among HCWs in SSA. It is very essential to evaluate the progress toward WHO’s hepatitis elimination goal by 2030 and inform policy makers. Materials and Methods Study design and strategy Search strategy Articles were searched from PubMed, Scopus, Embase, and Google Scholar. The search was conducted from January 2, 2025 until January 7, 2025. Search items, key terms and Boolean operator were used to search published articles such as Prevalence OR Magnitude AND “Hepatitis B Vaccine” OR “HBV vaccine” AND Coverage OR Uptake OR "Vaccination" AND "Health care workers" OR "HCW" OR “Health personnel” OR "Health provider" OR HCW* OR provider OR worker OR Health Professional AND “Sub-Saharan Africa”. Selection process Articles were downloaded and then duplicate studies were removed using Zotero citation software. Remaining Studies were screened by independent reviewers (TG, FG & EA) by their title and abstracts. Full texts of potential eligible studies were then independently assessed. All disagreement between the three authors were solved through consensus. Eligibility criteria The CoCoPop (Condition, Context, and Population) framework was used to construct a research question. Condition: Full dose Hepatitis B Vaccine uptake (as at least three doses of the hepatitis B vaccine) Context: Sub-Saharan Africa Population: All categories of HCWs in SSA, including doctors, nurses, midwives, laboratory personnel and other clinical staff with potential exposure to blood or body fluids in occupational settings. Inclusion and exclusion criteria Cross-sectional studies that reported full dose (three and above) among health care workers in SSA from January, 2017 G.C. until December 2024 G.C. with full text published in English were included for further analysis. Studies that didn’t report dose number and methodological poor quality were excluded. Search strategy Data extraction and risk of bias assessment Important data were extracted by three authors (TG, FG & EA) using extraction sheet prepared by Microsoft Excel 2019. Primary Author, Sub-Saharan Region, respective countries, year of publication, sampling technique, sample size, full dose of HBV vaccination, ever vaccinated, and associated factors with their odds ratio. All differences between authors were solved through further discussions. Joanna Briggs Institute’s (JBI) checklist for cross sectional studies was used to assess the quality and risk of bias of the studies. A criterion of 75% and above was set to include studies in the analysis. 14 from 18 studies scored 75% and above. 14 studies were included in this systematic review and meta-analysis. The average score was taken from the different result observed from the three authors. Data analysis STATA version 16.0 software was used for the analysis. Due to the variability of study setting and health care professions, Der Simonian and Laird’s random-effect model was used to estimate the pooled accounting for both with-in and between-studies variability. Heterogeneity between studies was assessed using Cochrane’s Q-test and I 2 statistics. I-squared (I 2 ). A subgroup analysis was conducted by region of SSA, mean age of participants, publication year to handle identify the cause for heterogeneity between studies. The level of influence from a single study on the pooled prevalence was checked by sensitivity analysis. Publication bias was also checked using funnel plot and Egger’s test. Results Study selection and identification Out of the 1,377 studies reviewed, 856 were excluded, because they were duplications. Articles were screened using their titles and abstracts, 489 studies were excluded to our study objective because they were irrelevant for this systematic review. Among the remaining studies, 14 studies were excluded because they didn’t report the outcome variable “full dose” and full texts were not found. 4 low quality studies were also excluded after assessed by JBI checklist for cross-sectional studies. 14 studies have been included for final review and analysis. The steps are summarized with Preferred Reporting Items for systematic Review and Meta-Analyses (PRISMA) reporting diagram (Fig. 1 ). Characteristics of the included studies From the fourteen studies included, ten (77.78%) of the studies were published in 2020 and later. All the studies included were cross-sectional studies. In total 7,376 study participants were included in this systematic review with a minimum and maximum sample size of 145 and 3132, respectively. The minimum full dose prevalence of around seven percent (6.9%) and maximum of almost eighty three percent (82.8%) were reported from the studies conducted in Nigeria ( 17 ) and Kenya ( 15 ) respectively. Each three studies from Ethiopia ( 18 – 20 ), Ghana ( 21 – 23 ), and Nigeria ( 17 , 24 , 25 ), one study from Uganda( 26 ), one study from Tanzania ( 27 ), one study from Kenya ( 15 ), one study from Somalia ( 28 ) and one study from South Sudan ( 29 ) were included in this study (Fig. 1 ). Study characteristic A total of 19 cross-sectional studies with total sample size of 8,870 participants were included in this systematic review and meta-analysis. The studies were conducted across various African regions: 8 in East Africa (Uganda, Tanzania, Kenya, Ethiopia, Somalia, South Sudan), 8 in West Africa (Ghana, Nigeria, Cameroon), and 1 in Southern Africa (Zambia). Sample sizes ranged from 145 participants to 3,132 participants. The Joanna Briggs Institute (JBI) quality appraisal scores of the included studies ranged from 6 to 8, indicating generally moderate to high methodological quality. Reported prevalence of full-dose hepatitis B vaccination coverage among health care workers varied widely, from as low as 2.8% in Somalia to as high as 82.8% in Kenya (Table 1 ). Table 1 study characteristics of Cross-sectional studies included for systematic review and meta-analysis No. primary author publication year region country study design JBI sample Prevalence (%) 1 Tonny Ssekamatte et al 2020 East Africa Uganda cross sectional 8 306 57.8 2 Vivian Efua Senoo-Dogbey et al 2024 West Africa Ghana cross sectional 8 340 46.8 3 Oluwatosin Idowu Oni 2022 West Africa Nigeria cross sectional 6 260 28.8 4 I. B. Omotowo 2018 West Africa Nigeria cross sectional 6 3132 6.9 5 Bernada Ndunguru 2023 East Africa Tanzania cross sectional 8 402 18.9 6 Irene Ann Mwangi 2023 East Africa Kenya cross sectional 7 145 82.8 7 Amudalat Issa 2023 West Africa Nigeria cross sectional 8 857 42 8 Nur Ahmed Hussein 2022 East Africa Somalia cross sectional 8 242 15.7 9 Getnet MA 2020 East Africa Ethiopia cross sectional 8 260 37.7 10 Elizabeth Tabitha Botchway 2020 West Africa Ghana cross sectional 7 303 78.6 11 Leta Bayissa 2024 East Africa Ethiopia cross sectional 8 428 36.9 12 Gloria Akosua Ansa 2019 West Africa Ghana cross sectional 8 161 42.3 13 John Bosco Alege 2020 East Africa South Sudan cross sectional 7 154 9.7 14 Mohammed Akibu 2018 East Africa Ethiopia cross sectional 7 386 25.6 15 Daniel Kobina Okwan 2024 West Africa Ghana Cross-sectional 8 530 43.6 16 Kassahun Haile 2021 East Africa Ethiopia Cross-sectional 8 417 5.8 17 Abdifitah Said Ali 2023 East Africa Somalia Cross-sectional 7 247 2.8 18 Fabrice Zobel Lekeumo Cheuyem 2023 West Africa Cameroon Cross-sectional 8 217 33.9 19 Namwaka Mungandi 2017 Southern Africa Zambia Cross-sectional 6 331 10.57 The pooled prevalence on full-dose of HBV vaccination among health-care workers in Sub-Saharan Africa The pooled prevalence of full-dose of HBV vaccination among health-care workers in Sub-Saharan Africa was 33% (95% CI = 24% – 42%). A Significant heterogeneity was observed among studies (I 2 = 99.36%, P-value < 0.001). The studies conducted in Nigeria by I. B. Omotowo et al. ( 17 ) and Amudalat Issabet al. ( 24 ), and also a study in Tanzania by Bernada Ndunguru et al. had the highest weight ( 27 ) (Fig. 2 ). Assessment of publication bias The estimated bias coefficient was 14.240 (Egger bias B = 14.24 (95% CI: 0.4547–28.033; p = 0.043)) with a standard error of 7.036. There was evidence for the presence of small-study effects. A trim-and-fill analysis was done with random effect model and it didn’t imputate additional studies. Sensitivity analysis no study influenced the overall pooled prevalence of full dose of HBV vaccination. The leave-one-out meta-analysis indicates a robust pooled prevalence estimate of 0.329 (32.9%) with a 95% confidence interval of 0.237 to 0.422. This estimate remains statistically significant (p < 0.001) even when individual studies are sequentially removed, suggesting that no single study disproportionately influences the overall result (Fig. 3 ). Sub-group analysis The test of group differences (Q = 15.17) had a p-value of 0.00. This shows there is a statistically significant difference in the pooled prevalence estimates among the East African, South African, and West African regions. The subgroup analysis by geographical region explains the source of heterogeneity and explain its contributing factor for the overall variability (Fig. 4 ). The pooled prevalence of full dose HBV vaccination among healthcare workers (54%; 95% CI: 22–86) was higher in those aged 30 years and lower compared to healthcare workers above the age of 30 years with I2 of 99.65%. The test of group difference had a p value of 0.92. The subgroup analysis based on age did not effectively explain the source of heterogeneity. High heterogeneity persisted within both age groups, and there was no significant difference in effect sizes between the groups (Fig. 5 ). The highest pooled prevalence of HBV vaccination was reported in articles published in 2021 and after (34%: CI: 16% − 51%). Both publication year subgroups exhibited extremely high and statistically significant heterogeneity. The "2021 or After" subgroup had an I2 of 99.23% (p = 0.00), and the "Before 2021" subgroup had an I2 of 99.49% (p = 0.00). test of group differences (Q = 0.01) yielded a p-value of 0.92. This shows there is no statistically significant difference in the pooled effect sizes. The subgroup analysis based on publication year did not effectively explain the source of heterogeneity (Fig. 6 ). T he Egger's test for small-study effects yielded a statistically significant result (beta1 = 16.63, p = 0.0002), rejecting the null hypothesis of no small-study effects. This finding suggests the presence of asymmetry in the funnel plot, which could be indicative of publication bias or small-study effects (Table 2 ). Table 2 Egger's test for small study effect parameter Estimate Standard Error z-value p-value β1​ (Intercept) 16.63 4.419 3.76 0.0002 Funnel plot The funnel plot provides strong visual evidence of asymmetry, supporting the significant result from the Egger's test. It suggests the likely presence of publication bias or other small-study effects (Fig. 7 ). Trim and fill nonparametric test while the funnel plot and Egger's regression test indicated statistically significant small-study effects or evidence of publication bias, the nonparametric trim-and-fill did not impute any studies. This suggests that no missing studies were imputed to correct publication bias. Consequently, the bias-adjusted pooled prevalence remains the same as the original observed pooled prevalence (0.329) (Table 3 ). Table 3 Trim and fill non-parametric test Studies prevalence [95% confidence interval] Observed 0.329 0.237–0.422 Observed + Imputed 0.329 0.237–0.422 Factors associated with full dose of HBV vaccination The study found gender has a significant association with full dose of HBV infection. From four studies all had significant association between gender and full dose of HBV vaccination. The study shows being male had 3.72 (95% CI: 1.23, 6.22) times more likely to be fully vaccinated for HBV compared to female health care workers, with statistically significant heterogeneity among studies (I 2 = 98.64%, P = 0.00) (Fig. 8 ). The study shows those who health workers who received training on infection were twice more likely to receive full dose of hepatitis b vaccination compared to those who never received the training (Fig. 9 . The study shows HCWs who were screened for HBV infection before were twice to be fully vaccinated compared to those who were not screened before (Fig. 10 ). Discussion The overall pooled prevalence of full dose of HBV vaccination was 33% (95% CI = 24% – 42%). which implies 67% of HCWs were not fully vaccinated. This low coverage is a challenge to achieve the global target set by WHO for the elimination of viral hepatitis by 2030. This indicates the persistent challenge of achieving full hepatitis vaccination coverage among HCW in Sub-Saharan African countries that puts them at a risk of acquiring hepatitis infection in workplace. This finding was higher from systematic review conducted in Ethiopia 20.04% (95% CI: 13.83, 26.26) ( 30 ). This difference might be due to health system disparities among countries in SSA. It was also higher from other SSA conducted in 2018: 24.7% (95% CI: 17.3–32.0 ( 10 ). The Difference could be while the former included studies from 2010 to 2017, the current study included studies from 2017 up to 2024. It can also show the efforts SSA countries made to vaccinate their work force. However, the finding was lower than a study done in Europe where 70–95% of HCWs are vaccinated ( 31 ). This might be due to the difference in socio-demographic status among SSA and Europe. Another reason can be HBV vaccination for HCWs is mandatory in most of Europe countries. In the sub-group analysis, the highest pooled prevalence of full dose of HBV vaccination was observed in West Africa (40%) and (36%) in East Africa. Whereas low in central Africa (11%) with only one study included. The difference might because of the difference in the sample size of the studies included in the meta-analysis. The largest sample size from the 19 studies included was 3132 participants from Nigeria and the smallest was 145 from Kenya ( 15 , 17 ). The pooled full dose of HBV vaccination (54%) was higher in the age category which is younger than 30 years. This is supported by evidence indicating recent graduates are more cautious of infection prevention practices, information about hepatitis reach to through different digital platforms easily and mandatory vaccination workplace policies for new employees. Also, the highest pooled full dose prevalence (39%) was reported in articles published in 2021 and after. This might be because of new vaccinated population and government and stakeholders’ involvement on increasing the coverage of HBV vaccine among HCWs over the years. The result of this meta-analysis showed that sex, training on infection prevention and screened before for HBV was statistically associated with full dose vaccination. Male healthcare workers were two times more likely to be fully vaccinated for HBV than female workers. This finding is consistent with a study done in Ethiopia, and other five developing countries ( 11 , 30 ). This might be due male are more likely to be more represented and constitutes majority of healthcare workforce in Sub-Saharan countries. It can also reflect a broader systemic gender inequalities in health system. Conclusion and recommendations This study revealed only 4 out of 10 health care workers are fully vaccinated for HBV. This implies a low full dose of HBV vaccination coverage among HCWs in SSA that put them at risk for hepatitis infection and further transmission to patients and other providers. Male health care workers, providers trained on infection prevention and screened before were found statistically significant with full dose of HBV vaccination uptake. The subgroup analysis also revealed providers aged above 30 years and female providers are less likely to be fully vaccinated. It highlights the need for targeted interventions for older professionals and policies by ministries and non-governmental organizations for female and older HCW to increase the vaccination uptake and decrease gender inequalities in workplaces. Health care workers who were screened before for hepatitis were also found to be vaccinated for full dose compared to be their counterparts. This implies routine hepatitis screening have to be implemented in health facilities. In addition, those who received infection prevention training were also found to be vaccination fully which suggests hospitals and health facilities should prepare and deliver health education tailored for health care providers working at clinical settings and at risk of hepatitis B infection to achieve full dose vaccination coverage. Further researches are needed to assess multiple factors that contributed for the low coverage of vaccination among health care workers in Sub-Saharan African countries. Strength and limitations of this review and meta-analysis This study assessed the prevalence of full dose of HBV vaccination among HCWs in SSA. Three reviewers checked the quality of each studies included, extracted the data which helped to prevent introducing bias to the final result. Subgroup and sensitivity analysis were also conducted to identify source of heterogeneity and small study effects. A weakness of this systematic review was: it only included articles from PubMed, Scopus, Embase, and Google Scholar only and published with English language, this could omit important studies that can only be found from other databases and gray literatures. This study also included studies from west Africa and East Africa and only on study from southern Africa to the final meta-analysis because studies retrieved from other region of SSA were found to be low quality. Another limitation of this study was the funnel plot and Egger's regression test indicated statistically significant small-study effects or evidence of publication bias. However nonparametric trim-and-fill did not impute any studies. This suggests that no missing studies were imputed to correct publication bias References Liang TJ (2009) Hepatitis B: the virus and disease. Hepatology 49(5 Suppl):S13–21. 10.1002/hep.22881 Sabeena S, Ravishankar N (2022) Horizontal modes of transmission of hepatitis B virus (HBV): a systematic review and meta-analysis. Iran J public health 51(10):2181. 10.18502/ijph.v51i10.10977 Sheena BS, Hiebert L, Han H, Ippolito H, Abbasi-Kangevari M, Abbasi-Kangevari Z et al (2022) Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. lancet Gastroenterol Hepatol 7(9):796–829. 10.1016/S2468-1253(22)00124-8 Organization WH (2015) Guidelines for the prevention care and treatment of persons with chronic hepatitis B infection: Mar-15. World Health Organization Organization WH Hepatitis fact sheets 2024 [updated 4/9/2024. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b#:~:text=Hepatitis%20B%20can%20cause%20a,a%20mother%20to%20her%20baby Aaron D, Nagu TJ, Rwegasha J, Komba E (2017) Hepatitis B vaccination coverage among healthcare workers at national hospital in Tanzania: how much, who and why? BMC Infect Dis 17:1–7. 10.1002/hep.22881 Mahamat G, Kenmoe S, Akazong EW, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A et al (2021) Global prevalence of hepatitis B virus serological markers among healthcare workers: A systematic review and meta-analysis. World J Hepatol 13(9):1190. 10.4254/wjh.v13.i9.1190 Organization WH (2016) Combating hepatitis B and C to reach elimination by 2030: advocacy brief. World Health Organization Schillie S (2018) Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations Rep 67. 10.1111/ajt.14763 Auta A, Adewuyi EO, Kureh GT, Onoviran N, Adeloye D (2018) Hepatitis B vaccination coverage among health-care workers in Africa: a systematic review and meta-analysis. Vaccine 36(32):4851–4860. 10.1016/j.vaccine.2018.06.043 Duodu PA, Darkwah E, Agbadi P, Duah HO, Nutor JJ (2022) Prevalence and geo-clinicodemographic factors associated with hepatitis B vaccination among healthcare workers in five developing countries. BMC Infect Dis 22(1):599. 10.1186/s12879-022-07556-3 Daniel FM, Ukoaka BM, Emeruwa VE, Oti-Ashong RC, Falaiye GO (2024) Addressing vaccination gaps among healthcare workers in Sub-Saharan Africa: the role of mandatory Hepatitis B vaccination. Trop Med Health 52(1):80. 10.1186/s41182-024-00652-x Mabunda N, Vieira L, Chelene I, Maueia C, Zicai AF, Duajá A et al (2022) Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City. Mozambique Plos one 17(10):e0276283. 10.1371/journal.pone.0276283 Ocan M, Acheng F, Otike C, Beinomugisha J, Katete D, Obua C (2022) Antibody levels and protection after Hepatitis B vaccine in adult vaccinated healthcare workers in northern Uganda. PLoS ONE 17(1):e0262126. 10.1371/journal.pone.0262126 Mwangi IA, Wesongah JO, Musyoki VM, Omosa-Manyonyi GS, Farah B, Edalia LG et al (2023) Assessment of hepatitis B vaccination status and hepatitis B surface antibody titres among health care workers in selected public health hospitals in Kenya. PLOS Global Public Health 3(4):e0001741. 10.1371/journal.pgph.0001741 Muvunyi CM, Harelimana JDD, Sebatunzi OR, Atmaprakash AC, Seruyange E, Masaisa F et al (2018) Hepatitis B vaccination coverage among healthcare workers at a tertiary hospital in Rwanda. BMC Res Notes 11:1–5. 10.1186/s13104-018-4002-5 Omotowo I, Meka I, Ijoma U, Okoli V, Obienu O, Nwagha T et al (2018) Uptake of hepatitis B vaccination and its determinants among health care workers in a tertiary health facility in Enugu, South-East, Nigeria. BMC Infect Dis 18:1–9. 10.1186/s12879-018-3191-9 Akibu M, Nurgi S, Tadese M, Tsega WD (2018) Attitude and vaccination status of healthcare workers against hepatitis B infection in a teaching hospital, Ethiopia. Scientifica 2018(1):6705305. 10.1155/2018/6705305 Bayissa L, Gela D, Boka A, Ararsa T (2024) Hepatitis B vaccination coverage and associated factors among nurses working at health centers in Addis Ababa, Ethiopia: a cross-sectional study. BMC nursing. ;23(1):600.DOI.10.1186/s12912-024-02224-0 Getnet MA, Bayu NH, Abtew MD, W/Mariam TGM, Hepatitis B (2020) Vaccination Uptake Rate and Predictors in Healthcare Professionals of Ethiopia. Risk Manage Healthc Policy 2875–2885. 10.2147/rmhp.s286488 Ansa GA, Ofor KNA, Houphoue EE, Amoabeng AA, Sifa JS, Odame GH (2019) Hepatitis B vaccine uptake among healthcare workers in a referral hospital, Accra. Pan Afr Med J 33(1). 10.11604/pamj.2019.33.96.18042 Botchway ET, Agyare E, Seyram L, Owusu KK, Mutocheluh M, Obiri-Yeboah D (2020) Prevalence and attitude towards hepatitis B vaccination among healthcare workers in a tertiary hospital in Ghana. Pan Afr Med J 36(1). 10.11604/pamj.2020.36.244.24085 Senoo-Dogbey VE, Anto F, Quansah R, Danso-Appiah A (2024) Completion of three-dose hepatitis B vaccination cycle and associated factors among health care workers in the Greater Accra Region of Ghana. PLoS ONE 19(4):e0298771. 10.1371/journal.pone.0298771 Issa A, Ayoola YA, Abdulkadir MB, Ibrahim RO, Oseni TIA, Abdullahi M et al (2023) Hepatitis B vaccination status among health workers in Nigeria: a nationwide survey between January to June 2021. Archives Public Health 81(1):123. 10.1186/s13690-023-01142-y Oni OI, Osho OP, Oluwole MT, Osho ES, Ogungbeje A, Raji HM (2022) Assessing the level of knowledge, uptake of hepatitis B virus vaccine, and its determinants among health workers across various levels of health facilities in Ondo, South West, Nigeria. Egypt J Intern Med 34(1):80. 10.1186/s43162-022-00167-z Ssekamatte T, Mukama T, Kibira SPS, Ndejjo R, Bukenya JN, Kimoga ZPA et al (2020) Hepatitis B screening and vaccination status of healthcare providers in Wakiso district, Uganda. PLoS ONE 15(7):e0235470. 10.1371/journal.pone.0235470 Ndunguru B, Wilfred D, Kapesa A, Kilonzo SD, Mirambo M, Hyera F et al (2023) Low uptake of hepatitis B vaccination among healthcare workers in primary health facilities in Mwanza region, North-Western Tanzania. Front Public Health 11:1152193DOI. /10.3389/fpubh.2023.1152193 Hussein NA, Ismail AM, Jama SS (2022) Assessment of hepatitis B vaccination status and associated factors among healthcare workers in Bosaso, Puntland, Somalia 2020. Biomed Res Int 2022(1):9074294. 10.1155/2022/9074294 Alege JB, Gulom G, Ochom A, Kaku VE (2020) Assessing level of knowledge and uptake of hepatitis B vaccination among health care workers at Juba Teaching Hospital, Juba City, South Sudan. Adv Prev Med 2020(1):8888409. 10.1155/2020/8888409 Awoke N, Mulgeta H, Lolaso T, Tekalign T, Samuel S, Obsa MS et al (2020) Full-dose hepatitis B virus vaccination coverage and associated factors among health care workers in Ethiopia: A systematic review and meta-analysis. PLoS One. ;15(10):e0241226.DOI.10.1371/journal.pone.0241226 De Schryver A, Lambaerts T, Lammertyn N, François G, Bulterys S, Godderis L (2020) European survey of hepatitis B vaccination policies for healthcare workers: An updated overview. Vaccine 38(11):2466–2472. 10.1016/j.vaccine.2020.02.003 Additional Declarations The authors declare no competing interests. Supplementary Files extracteddataHBV.xlsx Prismachecklist.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7667813","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":518280195,"identity":"11a4a670-5810-4bbc-9136-07cab6e69105","order_by":0,"name":"Tsegasilassie Gebremariam Abate","email":"data:image/png;base64,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","orcid":"","institution":"Lemi kura Subcity Health Office","correspondingAuthor":true,"prefix":"","firstName":"Tsegasilassie","middleName":"Gebremariam","lastName":"Abate","suffix":""},{"id":518280196,"identity":"849f42a4-7a24-45e0-8b7a-f162cf53735e","order_by":1,"name":"Eyob Akalewold Alemu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Eyob","middleName":"Akalewold","lastName":"Alemu","suffix":""},{"id":518280197,"identity":"117c6111-9f8d-4bad-b5b7-ca56e0686692","order_by":2,"name":"Fetlework Gubena Arage","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Fetlework","middleName":"Gubena","lastName":"Arage","suffix":""},{"id":518280198,"identity":"75c393aa-3f57-4abe-9d88-d71ee8cd8a16","order_by":3,"name":"Eliyas Addisu Taye","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Eliyas","middleName":"Addisu","lastName":"Taye","suffix":""},{"id":518280199,"identity":"edd05846-dfe2-4417-98c0-093ea1ba0ad5","order_by":4,"name":"Tigist Kiflie Tsegaw","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Tigist","middleName":"Kiflie","lastName":"Tsegaw","suffix":""},{"id":518280200,"identity":"0dfe70d5-0df7-48be-881b-9178ca643a2a","order_by":5,"name":"Zinabu Bekele Tadese","email":"","orcid":"","institution":"Semera University","correspondingAuthor":false,"prefix":"","firstName":"Zinabu","middleName":"Bekele","lastName":"Tadese","suffix":""}],"badges":[],"createdAt":"2025-09-21 14:28:31","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7667813/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7667813/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91984739,"identity":"c428641c-dd3f-47c3-90fa-7446922c66bb","added_by":"auto","created_at":"2025-09-23 11:41:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":580528,"visible":true,"origin":"","legend":"","description":"","filename":"HBV.docx","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/2e32aa34f35084f88fca40c4.docx"},{"id":91983454,"identity":"5f3c6c78-9888-4569-b6f1-39a3b570b9ca","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs7667813.json","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/1b0f6bd804042ed8db6c07f1.json"},{"id":91983456,"identity":"6d0e8fdf-8245-4399-82c8-ca517b71acad","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106731,"visible":true,"origin":"","legend":"","description":"","filename":"rs76678130enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/7fcedaf783f71317251464da.xml"},{"id":91983459,"identity":"1a9452f4-bd68-4a83-beb5-8ef47bdc05a3","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"eps","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":353,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage1.eps","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/db7d6cf896b0e8b4cc107b56.eps"},{"id":91984743,"identity":"88b5c805-cf9d-4276-9fc2-917771d6934d","added_by":"auto","created_at":"2025-09-23 11:41:03","extension":"eps","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":361,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage2.eps","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/8db948b3a07caa19304e1cd8.eps"},{"id":91984746,"identity":"4584fbd5-f3e9-43c8-8ac2-e0ad73f03c57","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"eps","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":353,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage1.eps","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/d74871097da02fa6bb2831ad.eps"},{"id":91983468,"identity":"fe4817da-aa9d-4702-8f32-221b3a6f6078","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"eps","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":362,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage4.eps","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/0b46fc4f17a4b8457ead8a43.eps"},{"id":91983470,"identity":"1d3b45ed-4cec-42c3-85a5-75707f342e94","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15479,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/04c0fdab7d7301890310a22a.png"},{"id":91983477,"identity":"f55d165e-4f07-4557-8a54-75d24e2b233b","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"jpeg","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":36239,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage10.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/6266d5448761fdc5a7c50155.jpeg"},{"id":91985142,"identity":"3d8d79ba-bce9-4529-b9ee-3f3eb97c49ce","added_by":"auto","created_at":"2025-09-23 11:49:04","extension":"jpeg","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23033,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage11.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/1198edd514113a2abf3235f0.jpeg"},{"id":91984751,"identity":"6de1c543-7a24-4d09-b1c8-89421f33880d","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"jpeg","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69953,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/d0f27938d6cb9b2a79ce91df.jpeg"},{"id":91983472,"identity":"cdd2e7f0-aa1d-4596-8276-feaa4725db04","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"jpeg","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":71335,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/e90c23c23b5faebd051e29b5.jpeg"},{"id":91985143,"identity":"b61faaf9-b132-4a51-9db8-163ee8d72f29","added_by":"auto","created_at":"2025-09-23 11:49:04","extension":"jpeg","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":464345,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/c7df6f9aa9c701c9e544854d.jpeg"},{"id":91983475,"identity":"35d78401-dbf4-46c7-94dc-1c8bb3ee240e","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"jpeg","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78903,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/be406c0ddd6055cb0dd48791.jpeg"},{"id":91984749,"identity":"b9c4a48c-16b5-4029-b4b7-d8cc19075154","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"jpeg","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":62630,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/14f9d15f064fcd8aac00eb2d.jpeg"},{"id":91984756,"identity":"02413684-8fc0-4f0f-9f15-1eea25e84526","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"jpeg","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81549,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/d26864a03c9962c9e232f9ee.jpeg"},{"id":91983488,"identity":"a1a34780-11d7-4a70-8e57-11c334a123fe","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"jpeg","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24429,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/f30cd3d43884987a66305674.jpeg"},{"id":91984753,"identity":"cf4e72af-6147-4ed6-aae0-609bccce190c","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"jpeg","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30012,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/bcee919e4fc961245de16bda.jpeg"},{"id":91983481,"identity":"a94f8098-850f-4890-8890-5548311d12f5","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14969,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/33a6daf54a71dcedbc8cad60.png"},{"id":91983478,"identity":"fcb1686c-5e0c-4eb0-8309-f0912bb1dc2c","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16107,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/67e0697ce0e671f8bd899faa.png"},{"id":91983484,"identity":"86b3d743-1d38-47bc-93bc-f90d927aff3d","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9743,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/266b9f14d1ae47beb077838f.png"},{"id":91985145,"identity":"82963d9e-68c4-41a8-b2ec-14bb75ce3687","added_by":"auto","created_at":"2025-09-23 11:49:04","extension":"png","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30098,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/309bdd5f9f3e0888dc74b29a.png"},{"id":91985146,"identity":"62f2b038-e48a-47bc-9ded-7223c8a22609","added_by":"auto","created_at":"2025-09-23 11:49:04","extension":"png","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25342,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/c103fe8555d08199d0f77de1.png"},{"id":91984760,"identity":"1cc1d426-7cf4-48e7-a105-959eb71a350e","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"png","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88379,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/f94d733bbed0687278dff249.png"},{"id":91985147,"identity":"2b9bbceb-bce0-4d22-ae2f-81265d16ace4","added_by":"auto","created_at":"2025-09-23 11:49:04","extension":"png","order_by":26,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35857,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/23bf25af0b5a1da0e9eacedf.png"},{"id":91984758,"identity":"e1534ac5-8629-4b1a-8eb0-ca8cef317b69","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"png","order_by":27,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":28888,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/a527e713b67c09c5cc83768b.png"},{"id":91983493,"identity":"e143cd73-f749-47cb-99ce-e4368027f4c8","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":28,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33738,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/83723e65313eff8b9fe2f1a2.png"},{"id":91983490,"identity":"c6c28ee5-1b0b-49e5-a4e9-7e716b18c666","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":29,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7708,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/cb2a06f17828eaab9f0281bc.png"},{"id":91983487,"identity":"25f4b2bb-56c5-4b26-913c-4486b4fa8740","added_by":"auto","created_at":"2025-09-23 11:33:04","extension":"png","order_by":30,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12956,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/9a7394fb6312f0331569b797.png"},{"id":91984759,"identity":"e4054c79-914f-4740-b915-c839ed57c228","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"xml","order_by":31,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105799,"visible":true,"origin":"","legend":"","description":"","filename":"rs76678130structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/edc89d5b2d0e814ac9e493ae.xml"},{"id":91984761,"identity":"dbe6f80d-1f97-430d-bb8d-dfa90458b13f","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"html","order_by":32,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115257,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/457cd0476250aed61f71a21a.html"},{"id":91984737,"identity":"28ad9a09-ca16-4db5-a21f-6271ed304185","added_by":"auto","created_at":"2025-09-23 11:41:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32609,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram of article selection for systematic review and meta-analysis\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/ba840643610314705b49cc0c.png"},{"id":91984738,"identity":"c8c56988-240b-44bc-9d6a-f425a4bf5c42","added_by":"auto","created_at":"2025-09-23 11:41:03","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69953,"visible":true,"origin":"","legend":"\u003cp\u003ePooled prevalence of full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/a07617666e844f2b395e0f4e.jpeg"},{"id":91983461,"identity":"becca7af-f57f-4f96-b41f-2c726863b28b","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71335,"visible":true,"origin":"","legend":"\u003cp\u003eSensitivity Analysis for pooled prevalence of full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/b328c72f928c9db6d5e686cb.jpeg"},{"id":91983464,"identity":"33b88974-7c57-4753-a71a-b72c7bf38d6e","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":78903,"visible":true,"origin":"","legend":"\u003cp\u003eSub-group analysis with region in SSA for pooled prevalence of full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/2e74b2791f21139ee3538e5c.jpeg"},{"id":91984741,"identity":"5ac1557b-419f-4e77-9703-51f10e20150d","added_by":"auto","created_at":"2025-09-23 11:41:03","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":62630,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSub-group analysis with mean age group of participants for pooled prevalence of full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/2bcc85e11f689c31fa36e2e7.jpeg"},{"id":91984742,"identity":"942e3da1-e971-4c17-816c-576c6754b456","added_by":"auto","created_at":"2025-09-23 11:41:03","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":81549,"visible":true,"origin":"","legend":"\u003cp\u003eSub-group analysis with publication year for pooled prevalence of full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/35c4bada02bf2f491f34dd30.jpeg"},{"id":91983467,"identity":"bc23d968-7124-4708-9eeb-1db59016f467","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":24429,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot to test the publication bias in 19 studies with 95% confidence limits.\u003c/p\u003e","description":"","filename":"image7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/3254ad87629ec46cf1f80a70.jpeg"},{"id":91984747,"identity":"0a740204-b0a1-47d6-b845-5fa32c33ff14","added_by":"auto","created_at":"2025-09-23 11:41:04","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":30012,"visible":true,"origin":"","legend":"\u003cp\u003ePooled effect of gender on full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/5d2fb18eb9406db370be73ab.jpeg"},{"id":91985140,"identity":"f3a92902-f9c7-48da-a939-80946179e6a5","added_by":"auto","created_at":"2025-09-23 11:49:03","extension":"jpeg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":36239,"visible":true,"origin":"","legend":"\u003cp\u003ePooled effect of IP training on full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/c9a042f8184b12cd635f19f4.jpeg"},{"id":91985141,"identity":"2e27eb04-dcb2-4f2e-b7ec-c8dcf7f28af6","added_by":"auto","created_at":"2025-09-23 11:49:04","extension":"jpeg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":23033,"visible":true,"origin":"","legend":"\u003cp\u003ePooled effect of hepatitis screening on full dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/p\u003e","description":"","filename":"image10.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/1c3820744abf60f70450a6b4.jpeg"},{"id":91986215,"identity":"b0ff52d5-6632-4330-85d7-f07401b3c38e","added_by":"auto","created_at":"2025-09-23 11:57:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1506669,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/4dec35d3-4130-4687-b1b5-fbbda3f9e9a6.pdf"},{"id":91983452,"identity":"138978d8-4611-4839-bf90-1ef5e3a7399b","added_by":"auto","created_at":"2025-09-23 11:33:03","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18889,"visible":true,"origin":"","legend":"","description":"","filename":"extracteddataHBV.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/4c9d969ec6a6eefe20071f13.xlsx"},{"id":91985139,"identity":"4a6ef158-ed2d-4944-9c23-74f2744eccfa","added_by":"auto","created_at":"2025-09-23 11:49:03","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":28178,"visible":true,"origin":"","legend":"","description":"","filename":"Prismachecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7667813/v1/c68034352ea9f8ce02c6655d.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFull dose of Hepatitis B vaccination and its associated factors among Healthcare workers in Sub-Saharan African countries: A Systematic review and Meta-analysis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHepatitis B virus (HBV) infection can lead to a multiple liver diseases and complication including acute and chronic hepatitis, cirrhosis, and also hepatocellular carcinoma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The virus is transmitted primarily through vertical transmission, sexual contact, and parenteral exposure with blood, blood products and body fluids (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is one of the major global public health problem, with nearly 1\u0026nbsp;million deaths annually, and an estimated 316\u0026nbsp;million people with chronic infection in 2019 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The World Health Organization (WHO) western pacific and African region contributes the highest endemicity with 97\u0026nbsp;million and 65\u0026nbsp;million cases, respectively (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHealthcare workers (HCWs) are at high risk of acquiring HBV infection due to their occupational exposure to blood, body fluid and needle-stick injuries (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Among HCWs working globally, approximately 3\u0026nbsp;million each year have exposure to HBV, leading to up to 66 thousand infections and 61 deaths (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In response, WHO recommend HBV vaccination for adults who are at risk of acquiring infection such as persons with current or recent injection drug use and HCWs, as part of its strategy to eliminate hepatitis by 2030 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). According to the Centers for Disease Control and Prevention (CDC), three dose of HBV vaccination provides an approximate protection rate of greater than 90% in individuals aged less than 40 years (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite this recommendation, full-dose HBV vaccination among HCWs remains suboptimal, particularly in low- and middle-income countries (LMICs) due to multiple reasons such as vaccine unavailability, higher costs and busy work schedules (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). A multi-country study in Afghanistan, Haiti, Malawi, Nepal, and Senegal revealed a significant disparities, with coverage ranging from 11.3% in Haiti to 69.1% in Afghanistan which was influenced by professional qualifications, education years and also gender (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Sub-Saharan Africa (SSA), the full-dose HBV vaccination coverage among HCWs ranges widely from 13.4% in central Africa to 42% in Nigeria (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A meta-analysis reported in 2018 showed the pooled estimated level in the region was 24.7% with the different coverage ranging from 13.4% in central Africa to 62.1% in Northen Africa (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAfter 2018, multiple primary studies assessed vaccination status among HCWs in SSA. In Mozambique, 13.3% of HCWs reported receiving full dose of vaccination (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Another study in Uganda, a cross-sectional study reported 81.3% of HCWs completed three doses series (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Studies in Kenya and Rwanda showed 53.1% and 96% completion rate of the three-dose schedule among HCWs, respectively (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese Current reports indicate there is continuing suboptimal and varied rates across the regions. There remains a critical need to update the pooled estimate of full-dose HBV vaccination coverage among HCW in SSA since 2017 and determine whether the coverage has improved, stayed the same or declined, and analyze regional disparities and determine factors associated with it. This study addresses these gaps by synthesizing data from studies published since 2017 to provide a current estimate of HBV vaccination coverage among HCWs in SSA. It is very essential to evaluate the progress toward WHO\u0026rsquo;s hepatitis elimination goal by 2030 and inform policy makers.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and strategy\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eSearch strategy\u003c/h2\u003e\u003cp\u003eArticles were searched from PubMed, Scopus, Embase, and Google Scholar. The search was conducted from January 2, 2025 until January 7, 2025. Search items, key terms and Boolean operator were used to search published articles such as Prevalence OR Magnitude AND \u0026ldquo;Hepatitis B Vaccine\u0026rdquo; OR \u0026ldquo;HBV vaccine\u0026rdquo; AND Coverage OR Uptake OR \"Vaccination\" AND \"Health care workers\" OR \"HCW\" OR \u0026ldquo;Health personnel\u0026rdquo; OR \"Health provider\" OR HCW* OR provider OR worker OR Health Professional AND \u0026ldquo;Sub-Saharan Africa\u0026rdquo;.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eSelection process\u003c/h3\u003e\n\u003cp\u003eArticles were downloaded and then duplicate studies were removed using Zotero citation software. Remaining Studies were screened by independent reviewers (TG, FG \u0026amp; EA) by their title and abstracts. Full texts of potential eligible studies were then independently assessed. All disagreement between the three authors were solved through consensus.\u003c/p\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eThe CoCoPop (Condition, Context, and Population) framework was used to construct a research question.\u003c/p\u003e\u003cp\u003eCondition: Full dose Hepatitis B Vaccine uptake (as at least three doses of the hepatitis B vaccine)\u003c/p\u003e\u003cp\u003eContext: Sub-Saharan Africa\u003c/p\u003e\u003cp\u003ePopulation: All categories of HCWs in SSA, including doctors, nurses, midwives, laboratory personnel and other clinical staff with potential exposure to blood or body fluids in occupational settings.\u003c/p\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eCross-sectional studies that reported full dose (three and above) among health care workers in SSA from January, 2017 G.C. until December 2024 G.C. with full text published in English were included for further analysis. Studies that didn\u0026rsquo;t report dose number and methodological poor quality were excluded.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSearch strategy\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003eData extraction and risk of bias assessment\u003c/h2\u003e\u003cp\u003eImportant data were extracted by three authors (TG, FG \u0026amp; EA) using extraction sheet prepared by Microsoft Excel 2019. Primary Author, Sub-Saharan Region, respective countries, year of publication, sampling technique, sample size, full dose of HBV vaccination, ever vaccinated, and associated factors with their odds ratio. All differences between authors were solved through further discussions.\u003c/p\u003e\u003cp\u003eJoanna Briggs Institute\u0026rsquo;s (JBI) checklist for cross sectional studies was used to assess the quality and risk of bias of the studies. A criterion of 75% and above was set to include studies in the analysis. 14 from 18 studies scored 75% and above. 14 studies were included in this systematic review and meta-analysis. The average score was taken from the different result observed from the three authors.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eSTATA version 16.0 software was used for the analysis. Due to the variability of study setting and health care professions, Der Simonian and Laird\u0026rsquo;s random-effect model was used to estimate the pooled accounting for both with-in and between-studies variability. Heterogeneity between studies was assessed using Cochrane\u0026rsquo;s Q-test and I\u003csup\u003e2\u003c/sup\u003e statistics. I-squared (I\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e\u003cp\u003eA subgroup analysis was conducted by region of SSA, mean age of participants, publication year to handle identify the cause for heterogeneity between studies. The level of influence from a single study on the pooled prevalence was checked by sensitivity analysis. Publication bias was also checked using funnel plot and Egger\u0026rsquo;s test.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStudy selection and identification\u003c/h2\u003e\u003cp\u003eOut of the 1,377 studies reviewed, 856 were excluded, because they were duplications. Articles were screened using their titles and abstracts, 489 studies were excluded to our study objective because they were irrelevant for this systematic review. Among the remaining studies, 14 studies were excluded because they didn\u0026rsquo;t report the outcome variable \u0026ldquo;full dose\u0026rdquo; and full texts were not found. 4 low quality studies were also excluded after assessed by JBI checklist for cross-sectional studies. 14 studies have been included for final review and analysis. The steps are summarized with Preferred Reporting Items for systematic Review and Meta-Analyses (PRISMA) reporting diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of the included studies\u003c/h2\u003e\u003cp\u003eFrom the fourteen studies included, ten (77.78%) of the studies were published in 2020 and later. All the studies included were cross-sectional studies. In total 7,376 study participants were included in this systematic review with a minimum and maximum sample size of 145 and 3132, respectively. The minimum full dose prevalence of around seven percent (6.9%) and maximum of almost eighty three percent (82.8%) were reported from the studies conducted in Nigeria (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and Kenya (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) respectively. Each three studies from Ethiopia (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), Ghana (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), and Nigeria (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), one study from Uganda(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), one study from Tanzania (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), one study from Kenya (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), one study from Somalia (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and one study from South Sudan (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) were included in this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eStudy characteristic\u003c/h2\u003e\u003cp\u003eA total of 19 cross-sectional studies with total sample size of 8,870 participants were included in this systematic review and meta-analysis. The studies were conducted across various African regions: 8 in East Africa (Uganda, Tanzania, Kenya, Ethiopia, Somalia, South Sudan), 8 in West Africa (Ghana, Nigeria, Cameroon), and 1 in Southern Africa (Zambia). Sample sizes ranged from 145 participants to 3,132 participants. The Joanna Briggs Institute (JBI) quality appraisal scores of the included studies ranged from 6 to 8, indicating generally moderate to high methodological quality. Reported prevalence of full-dose hepatitis B vaccination coverage among health care workers varied widely, from as low as 2.8% in Somalia to as high as 82.8% in Kenya (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003estudy characteristics of Cross-sectional studies included for systematic review and meta-analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eprimary author\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003epublication year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eregion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003estudy design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eJBI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003esample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePrevalence (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTonny Ssekamatte et al\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e57.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVivian Efua Senoo-Dogbey et al\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGhana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e46.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOluwatosin Idowu Oni\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e28.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI. B. Omotowo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBernada Ndunguru\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTanzania\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIrene Ann Mwangi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eKenya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmudalat Issa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNur Ahmed Hussein\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSomalia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGetnet MA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e37.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElizabeth Tabitha Botchway\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGhana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e78.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeta Bayissa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e428\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e36.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGloria Akosua Ansa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGhana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e42.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJohn Bosco Alege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSouth Sudan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMohammed Akibu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e25.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDaniel Kobina Okwan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGhana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCross-sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e43.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKassahun Haile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCross-sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbdifitah Said Ali\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEast Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSomalia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCross-sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFabrice Zobel Lekeumo Cheuyem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWest Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCameroon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCross-sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNamwaka Mungandi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSouthern Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZambia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCross-sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e10.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eThe pooled prevalence on full-dose of HBV vaccination among health-care workers in Sub-Saharan Africa\u003c/h2\u003e\u003cp\u003eThe pooled prevalence of full-dose of HBV vaccination among health-care workers in Sub-Saharan Africa was 33% (95% CI\u0026thinsp;=\u0026thinsp;24% \u0026ndash; 42%). A Significant heterogeneity was observed among studies (I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;99.36%, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The studies conducted in Nigeria by I. B. Omotowo et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and Amudalat Issabet al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and also a study in Tanzania by Bernada Ndunguru et al. had the highest weight (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eAssessment of publication bias\u003c/h2\u003e\u003cp\u003eThe estimated bias coefficient was 14.240 (Egger bias B\u0026thinsp;=\u0026thinsp;14.24 (95% CI: 0.4547\u0026ndash;28.033; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043)) with a standard error of 7.036. There was evidence for the presence of small-study effects. A trim-and-fill analysis was done with random effect model and it didn\u0026rsquo;t imputate additional studies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSensitivity analysis\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eno study influenced the overall pooled prevalence of full dose of HBV vaccination. The leave-one-out meta-analysis indicates a robust pooled prevalence estimate of 0.329 (32.9%) with a 95% confidence interval of 0.237 to 0.422. This estimate remains statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) even when individual studies are sequentially removed, suggesting that no single study disproportionately influences the overall result (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eSub-group analysis\u003c/h2\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe test of group differences (Q\u0026thinsp;=\u0026thinsp;15.17) had a p-value of 0.00. This shows there is a statistically significant difference in the pooled prevalence estimates among the East African, South African, and West African regions. The subgroup analysis by geographical region explains the source of heterogeneity and explain its contributing factor for the overall variability (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe pooled prevalence of full dose HBV vaccination among healthcare workers (54%; 95% CI: 22\u0026ndash;86) was higher in those aged 30 years and lower compared to healthcare workers above the age of 30 years with I2 of 99.65%. The test of group difference had a p value of 0.92. The subgroup analysis based on age did not effectively explain the source of heterogeneity. High heterogeneity persisted within both age groups, and there was no significant difference in effect sizes between the groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe highest pooled prevalence of HBV vaccination was reported in articles published in 2021 and after (34%: CI: 16% \u0026minus;\u0026thinsp;51%). Both publication year subgroups exhibited extremely high and statistically significant heterogeneity. The \"2021 or After\" subgroup had an I2 of 99.23% (p\u0026thinsp;=\u0026thinsp;0.00), and the \"Before 2021\" subgroup had an I2 of 99.49% (p\u0026thinsp;=\u0026thinsp;0.00). test of group differences (Q\u0026thinsp;=\u0026thinsp;0.01) yielded a p-value of 0.92. This shows there is no statistically significant difference in the pooled effect sizes. The subgroup analysis based on publication year did not effectively explain the source of heterogeneity (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eT\u003c/b\u003ehe Egger's test for small-study effects yielded a statistically significant result (beta1\u0026thinsp;=\u0026thinsp;16.63, p\u0026thinsp;=\u0026thinsp;0.0002), rejecting the null hypothesis of no small-study effects. This finding suggests the presence of asymmetry in the funnel plot, which could be indicative of publication bias or small-study effects (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEgger's test for small study effect\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eparameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEstimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ez-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eβ1​ (Intercept)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eFunnel plot\u003c/h2\u003e\u003cp\u003eThe funnel plot provides strong visual evidence of asymmetry, supporting the significant result from the Egger's test. It suggests the likely presence of publication bias or other small-study effects (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTrim and fill nonparametric test\u003c/h2\u003e\u003cp\u003ewhile the funnel plot and Egger's regression test indicated statistically significant small-study effects or evidence of publication bias, the nonparametric trim-and-fill did not impute any studies. This suggests that no missing studies were imputed to correct publication bias. Consequently, the bias-adjusted pooled prevalence remains the same as the original observed pooled prevalence (0.329) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTrim and fill non-parametric test\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eprevalence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[95% confidence interval]\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObserved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.237\u0026ndash;0.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObserved\u0026thinsp;+\u0026thinsp;Imputed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.237\u0026ndash;0.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with full dose of HBV vaccination\u003c/h2\u003e\u003cp\u003eThe study found gender has a significant association with full dose of HBV infection. From four studies all had significant association between gender and full dose of HBV vaccination. The study shows being male had 3.72 (95% CI: 1.23, 6.22) times more likely to be fully vaccinated for HBV compared to female health care workers, with statistically significant heterogeneity among studies (I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;98.64%, P\u0026thinsp;=\u0026thinsp;0.00) (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe study shows those who health workers who received training on infection were twice more likely to receive full dose of hepatitis b vaccination compared to those who never received the training (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe study shows HCWs who were screened for HBV infection before were twice to be fully vaccinated compared to those who were not screened before (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overall pooled prevalence of full dose of HBV vaccination was 33% (95% CI\u0026thinsp;=\u0026thinsp;24% \u0026ndash; 42%). which implies 67% of HCWs were not fully vaccinated. This low coverage is a challenge to achieve the global target set by WHO for the elimination of viral hepatitis by 2030. This indicates the persistent challenge of achieving full hepatitis vaccination coverage among HCW in Sub-Saharan African countries that puts them at a risk of acquiring hepatitis infection in workplace.\u003c/p\u003e\u003cp\u003eThis finding was higher from systematic review conducted in Ethiopia 20.04% (95% CI: 13.83, 26.26) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This difference might be due to health system disparities among countries in SSA. It was also higher from other SSA conducted in 2018: 24.7% (95% CI: 17.3\u0026ndash;32.0 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The Difference could be while the former included studies from 2010 to 2017, the current study included studies from 2017 up to 2024. It can also show the efforts SSA countries made to vaccinate their work force. However, the finding was lower than a study done in Europe where 70\u0026ndash;95% of HCWs are vaccinated (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This might be due to the difference in socio-demographic status among SSA and Europe. Another reason can be HBV vaccination for HCWs is mandatory in most of Europe countries.\u003c/p\u003e\u003cp\u003eIn the sub-group analysis, the highest pooled prevalence of full dose of HBV vaccination was observed in West Africa (40%) and (36%) in East Africa. Whereas low in central Africa (11%) with only one study included. The difference might because of the difference in the sample size of the studies included in the meta-analysis. The largest sample size from the 19 studies included was 3132 participants from Nigeria and the smallest was 145 from Kenya (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe pooled full dose of HBV vaccination (54%) was higher in the age category which is younger than 30 years. This is supported by evidence indicating recent graduates are more cautious of infection prevention practices, information about hepatitis reach to through different digital platforms easily and mandatory vaccination workplace policies for new employees. Also, the highest pooled full dose prevalence (39%) was reported in articles published in 2021 and after. This might be because of new vaccinated population and government and stakeholders\u0026rsquo; involvement on increasing the coverage of HBV vaccine among HCWs over the years.\u003c/p\u003e\u003cp\u003eThe result of this meta-analysis showed that sex, training on infection prevention and screened before for HBV was statistically associated with full dose vaccination. Male healthcare workers were two times more likely to be fully vaccinated for HBV than female workers. This finding is consistent with a study done in Ethiopia, and other five developing countries (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This might be due male are more likely to be more represented and constitutes majority of healthcare workforce in Sub-Saharan countries. It can also reflect a broader systemic gender inequalities in health system.\u003c/p\u003e"},{"header":"Conclusion and recommendations","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003cp\u003eThis study revealed only 4 out of 10 health care workers are fully vaccinated for HBV. This implies a low full dose of HBV vaccination coverage among HCWs in SSA that put them at risk for hepatitis infection and further transmission to patients and other providers. Male health care workers, providers trained on infection prevention and screened before were found statistically significant with full dose of HBV vaccination uptake. The subgroup analysis also revealed providers aged above 30 years and female providers are less likely to be fully vaccinated. It highlights the need for targeted interventions for older professionals and policies by ministries and non-governmental organizations for female and older HCW to increase the vaccination uptake and decrease gender inequalities in workplaces. Health care workers who were screened before for hepatitis were also found to be vaccinated for full dose compared to be their counterparts. This implies routine hepatitis screening have to be implemented in health facilities. In addition, those who received infection prevention training were also found to be vaccination fully which suggests hospitals and health facilities should prepare and deliver health education tailored for health care providers working at clinical settings and at risk of hepatitis B infection to achieve full dose vaccination coverage. Further researches are needed to assess multiple factors that contributed for the low coverage of vaccination among health care workers in Sub-Saharan African countries.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eStrength and limitations of this review and meta-analysis\u003c/h2\u003e\u003cp\u003eThis study assessed the prevalence of full dose of HBV vaccination among HCWs in SSA. Three reviewers checked the quality of each studies included, extracted the data which helped to prevent introducing bias to the final result. Subgroup and sensitivity analysis were also conducted to identify source of heterogeneity and small study effects. A weakness of this systematic review was: it only included articles from PubMed, Scopus, Embase, and Google Scholar only and published with English language, this could omit important studies that can only be found from other databases and gray literatures. This study also included studies from west Africa and East Africa and only on study from southern Africa to the final meta-analysis because studies retrieved from other region of SSA were found to be low quality. Another limitation of this study was the funnel plot and Egger's regression test indicated statistically significant small-study effects or evidence of publication bias. However nonparametric trim-and-fill did not impute any studies. This suggests that no missing studies were imputed to correct publication bias\u003c/p\u003e\u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLiang TJ (2009) Hepatitis B: the virus and disease. Hepatology 49(5 Suppl):S13\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/hep.22881\u003c/span\u003e\u003cspan address=\"10.1002/hep.22881\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSabeena S, Ravishankar N (2022) Horizontal modes of transmission of hepatitis B virus (HBV): a systematic review and meta-analysis. Iran J public health 51(10):2181. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18502/ijph.v51i10.10977\u003c/span\u003e\u003cspan address=\"10.18502/ijph.v51i10.10977\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSheena BS, Hiebert L, Han H, Ippolito H, Abbasi-Kangevari M, Abbasi-Kangevari Z et al (2022) Global, regional, and national burden of hepatitis B, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. lancet Gastroenterol Hepatol 7(9):796\u0026ndash;829. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2468-1253(22)00124-8\u003c/span\u003e\u003cspan address=\"10.1016/S2468-1253(22)00124-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH (2015) Guidelines for the prevention care and treatment of persons with chronic hepatitis B infection: Mar-15. World Health Organization\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH Hepatitis fact sheets 2024 [updated 4/9/2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/hepatitis-b#:~:text=Hepatitis%20B%20can%20cause%20a,a%20mother%20to%20her%20baby\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/hepatitis-b#:~:text=Hepatitis%20B%20can%20cause%20a,a%20mother%20to%20her%20baby\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAaron D, Nagu TJ, Rwegasha J, Komba E (2017) Hepatitis B vaccination coverage among healthcare workers at national hospital in Tanzania: how much, who and why? BMC Infect Dis 17:1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/hep.22881\u003c/span\u003e\u003cspan address=\"10.1002/hep.22881\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahamat G, Kenmoe S, Akazong EW, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A et al (2021) Global prevalence of hepatitis B virus serological markers among healthcare workers: A systematic review and meta-analysis. World J Hepatol 13(9):1190. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4254/wjh.v13.i9.1190\u003c/span\u003e\u003cspan address=\"10.4254/wjh.v13.i9.1190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH (2016) Combating hepatitis B and C to reach elimination by 2030: advocacy brief. World Health Organization\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchillie S (2018) Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations Rep 67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ajt.14763\u003c/span\u003e\u003cspan address=\"10.1111/ajt.14763\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAuta A, Adewuyi EO, Kureh GT, Onoviran N, Adeloye D (2018) Hepatitis B vaccination coverage among health-care workers in Africa: a systematic review and meta-analysis. Vaccine 36(32):4851\u0026ndash;4860. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.vaccine.2018.06.043\u003c/span\u003e\u003cspan address=\"10.1016/j.vaccine.2018.06.043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDuodu PA, Darkwah E, Agbadi P, Duah HO, Nutor JJ (2022) Prevalence and geo-clinicodemographic factors associated with hepatitis B vaccination among healthcare workers in five developing countries. BMC Infect Dis 22(1):599. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-022-07556-3\u003c/span\u003e\u003cspan address=\"10.1186/s12879-022-07556-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaniel FM, Ukoaka BM, Emeruwa VE, Oti-Ashong RC, Falaiye GO (2024) Addressing vaccination gaps among healthcare workers in Sub-Saharan Africa: the role of mandatory Hepatitis B vaccination. Trop Med Health 52(1):80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s41182-024-00652-x\u003c/span\u003e\u003cspan address=\"10.1186/s41182-024-00652-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMabunda N, Vieira L, Chelene I, Maueia C, Zicai AF, Duaj\u0026aacute; A et al (2022) Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City. Mozambique Plos one 17(10):e0276283. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0276283\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0276283\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOcan M, Acheng F, Otike C, Beinomugisha J, Katete D, Obua C (2022) Antibody levels and protection after Hepatitis B vaccine in adult vaccinated healthcare workers in northern Uganda. PLoS ONE 17(1):e0262126. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0262126\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0262126\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMwangi IA, Wesongah JO, Musyoki VM, Omosa-Manyonyi GS, Farah B, Edalia LG et al (2023) Assessment of hepatitis B vaccination status and hepatitis B surface antibody titres among health care workers in selected public health hospitals in Kenya. PLOS Global Public Health 3(4):e0001741. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pgph.0001741\u003c/span\u003e\u003cspan address=\"10.1371/journal.pgph.0001741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuvunyi CM, Harelimana JDD, Sebatunzi OR, Atmaprakash AC, Seruyange E, Masaisa F et al (2018) Hepatitis B vaccination coverage among healthcare workers at a tertiary hospital in Rwanda. BMC Res Notes 11:1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13104-018-4002-5\u003c/span\u003e\u003cspan address=\"10.1186/s13104-018-4002-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOmotowo I, Meka I, Ijoma U, Okoli V, Obienu O, Nwagha T et al (2018) Uptake of hepatitis B vaccination and its determinants among health care workers in a tertiary health facility in Enugu, South-East, Nigeria. BMC Infect Dis 18:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-018-3191-9\u003c/span\u003e\u003cspan address=\"10.1186/s12879-018-3191-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkibu M, Nurgi S, Tadese M, Tsega WD (2018) Attitude and vaccination status of healthcare workers against hepatitis B infection in a teaching hospital, Ethiopia. Scientifica 2018(1):6705305. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2018/6705305\u003c/span\u003e\u003cspan address=\"10.1155/2018/6705305\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBayissa L, Gela D, Boka A, Ararsa T (2024) Hepatitis B vaccination coverage and associated factors among nurses working at health centers in Addis Ababa, Ethiopia: a cross-sectional study. BMC nursing. ;23(1):600.DOI.10.1186/s12912-024-02224-0\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGetnet MA, Bayu NH, Abtew MD, W/Mariam TGM, Hepatitis B (2020) Vaccination Uptake Rate and Predictors in Healthcare Professionals of Ethiopia. Risk Manage Healthc Policy 2875\u0026ndash;2885. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/rmhp.s286488\u003c/span\u003e\u003cspan address=\"10.2147/rmhp.s286488\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnsa GA, Ofor KNA, Houphoue EE, Amoabeng AA, Sifa JS, Odame GH (2019) Hepatitis B vaccine uptake among healthcare workers in a referral hospital, Accra. Pan Afr Med J 33(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11604/pamj.2019.33.96.18042\u003c/span\u003e\u003cspan address=\"10.11604/pamj.2019.33.96.18042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBotchway ET, Agyare E, Seyram L, Owusu KK, Mutocheluh M, Obiri-Yeboah D (2020) Prevalence and attitude towards hepatitis B vaccination among healthcare workers in a tertiary hospital in Ghana. Pan Afr Med J 36(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.11604/pamj.2020.36.244.24085\u003c/span\u003e\u003cspan address=\"10.11604/pamj.2020.36.244.24085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSenoo-Dogbey VE, Anto F, Quansah R, Danso-Appiah A (2024) Completion of three-dose hepatitis B vaccination cycle and associated factors among health care workers in the Greater Accra Region of Ghana. PLoS ONE 19(4):e0298771. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0298771\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0298771\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIssa A, Ayoola YA, Abdulkadir MB, Ibrahim RO, Oseni TIA, Abdullahi M et al (2023) Hepatitis B vaccination status among health workers in Nigeria: a nationwide survey between January to June 2021. Archives Public Health 81(1):123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13690-023-01142-y\u003c/span\u003e\u003cspan address=\"10.1186/s13690-023-01142-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOni OI, Osho OP, Oluwole MT, Osho ES, Ogungbeje A, Raji HM (2022) Assessing the level of knowledge, uptake of hepatitis B virus vaccine, and its determinants among health workers across various levels of health facilities in Ondo, South West, Nigeria. Egypt J Intern Med 34(1):80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s43162-022-00167-z\u003c/span\u003e\u003cspan address=\"10.1186/s43162-022-00167-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSsekamatte T, Mukama T, Kibira SPS, Ndejjo R, Bukenya JN, Kimoga ZPA et al (2020) Hepatitis B screening and vaccination status of healthcare providers in Wakiso district, Uganda. PLoS ONE 15(7):e0235470. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0235470\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0235470\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNdunguru B, Wilfred D, Kapesa A, Kilonzo SD, Mirambo M, Hyera F et al (2023) Low uptake of hepatitis B vaccination among healthcare workers in primary health facilities in Mwanza region, North-Western Tanzania. Front Public Health 11:1152193DOI. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e/10.3389/fpubh.2023.1152193\u003c/span\u003e\u003cspan address=\"/10.3389/fpubh.2023.1152193\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHussein NA, Ismail AM, Jama SS (2022) Assessment of hepatitis B vaccination status and associated factors among healthcare workers in Bosaso, Puntland, Somalia 2020. Biomed Res Int 2022(1):9074294. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2022/9074294\u003c/span\u003e\u003cspan address=\"10.1155/2022/9074294\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlege JB, Gulom G, Ochom A, Kaku VE (2020) Assessing level of knowledge and uptake of hepatitis B vaccination among health care workers at Juba Teaching Hospital, Juba City, South Sudan. Adv Prev Med 2020(1):8888409. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2020/8888409\u003c/span\u003e\u003cspan address=\"10.1155/2020/8888409\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwoke N, Mulgeta H, Lolaso T, Tekalign T, Samuel S, Obsa MS et al (2020) Full-dose hepatitis B virus vaccination coverage and associated factors among health care workers in Ethiopia: A systematic review and meta-analysis. PLoS One. ;15(10):e0241226.DOI.10.1371/journal.pone.0241226\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Schryver A, Lambaerts T, Lammertyn N, Fran\u0026ccedil;ois G, Bulterys S, Godderis L (2020) European survey of hepatitis B vaccination policies for healthcare workers: An updated overview. Vaccine 38(11):2466\u0026ndash;2472. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.vaccine.2020.02.003\u003c/span\u003e\u003cspan address=\"10.1016/j.vaccine.2020.02.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University Of Gondar","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis B virus, Immunization, Developing countries, Health personnel","lastPublishedDoi":"10.21203/rs.3.rs-7667813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7667813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn low-income countries, especially in Sub-Saharan Africa, the low uptake of hepatitis B vaccine, coupled with high infection burden for hepatitis B, makes health-care workers vulnerable for acquiring the infection. The objective of this study was to determine the pooled prevalence of full dose of hepatitis B vaccine and identify associated factors among health care workers in Sub-Saharan Africa.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003ePubMed, Scopus, Embase, and Google Scholar were systematically searched using Boolean operators. Eligible cross-sectional studies published from January 2017 to December 2024 in English with a quality score of 75% and above using Joanna Briggs Institute\u0026rsquo;s checklist were included for further review and analysis. Studies were screened for their consistency with the title, abstract and research question. The pooled prevalence of full dose hepatitis B vaccination and the effect size of associated factors were estimated using DerSimonian and Laird\u0026rsquo;s random-effect model. Heterogeneity among studies was assessed using I\u0026sup2; statistic and Cochran\u0026rsquo;s Q test. Subgroup analysis and sensitivity analysis were conducted to identify the source of heterogeneity and the effect of single study effect on the pooled estimates. Egger\u0026rsquo;s test, funnel plot and trim and fill was also performed to assess publication bias.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003e19 studies out of 1377 articles assessed met the inclusion criteria and were included for further analysis. The estimated pooled full dose of HBV vaccine among health care workers was 38% (95% CI: 24%\u0026ndash;51%). Male gender, training on infection prevention and screened for hepatitis b virus before were found to be significant factors associated with full dose vaccination.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe level of full dose vaccination for Hepatitis B vaccination among health care workers was low and needs more attention. Routine hepatitis screening and infection prevention training contributes for the full coverage of hepatitis B vaccination among health care workers. Hospitals and health facilities should prepare and deliver health education tailored for health care providers working at clinical settings and at risk of hepatitis B infection to achieve full dose vaccination coverage. Policies, strategies, campaigns and educations have to implemented to improve HBV vaccination for health care workers in Sub-Saharan Africa with a particular attention for female providers .\u003c/p\u003e\u003ch2\u003eRegistration:\u003c/h2\u003e\u003cp\u003eThis systematic review protocol was registered on PROSPERO with ID CRD42025635990\u003c/p\u003e","manuscriptTitle":"Full dose of Hepatitis B vaccination and its associated factors among Healthcare workers in Sub-Saharan African countries: A Systematic review and Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 11:32:58","doi":"10.21203/rs.3.rs-7667813/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"42f0d190-9fa3-4ef9-b417-edd0fb6fb580","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T11:32:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 11:32:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7667813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7667813","identity":"rs-7667813","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}